MEDICARE: MELISSA KATE RENDER CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	209012608	IL

General Provider Information

NPI Number	:	1285028308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA KATE RENDER CRNA

Provider Business Mailing Address
First Line	:	332 HAZEL AVE
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62223-1636
Country	:	US
Telephone Number	:	618-416-6332
Fax Number	:

Provider Business Practice Location Address
First Line	:	5921 MERIDIAN WOODS
Second Line	:
City	:	GLEN CARBON
State	:	IL
Zip	:	62034-1545
Country	:	US
Telephone Number	:	314-753-2222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2015
Last Update Date	:	03/26/2015

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